Billing code 63191: Nerve incisionMedicare rate & RVUs in Washington
Reports operative incision or division of the spinal accessory nerve, including selected procedures for severe cervical dystonia when that nerve is the surgical target.
CMS doesn’t publish an office rate for 63191 in Washington.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 63191 covers
The surgeon exposes and incises or divides the spinal accessory nerve as the intended neural target. A neurosurgeon or other surgeon qualified to perform the procedure may use it in selected cases of severe cervical dystonia or spasmodic torticollis. The operative report should identify the spinal accessory nerve and describe the surgical work performed; procedures on spinal nerve roots or spinal cord tracts involve different targets.
Report 63191 when the documented operation is directed at the spinal accessory nerve, not simply because another cervical nerve procedure was performed. Record the indication, laterality, nerve treated, and operative details supporting the service. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 63191 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,349.32 |
| Seattle (King Cnty) | Unavailable | $1,473.83 |
How the 63191 rate is calculated
Each of 63191’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 63191
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 18.45Practice expense 15.00Malpractice 7.77
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 63191
63191 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 63191
Nerve incision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.11/0.76/0.13 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 63191
Nerve incision
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
63191 without 50 · national facility
$1,376.79
Nerve incision
63191-50 · Bilateral: 150%
$2,065.19
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
63191 compared with similar codes
Compare codes
63191 vs 63185 vs 63190 vs 63170: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 63185Spinal rhizotomy
- 63185 concerns a spinal nerve procedure with limited segment involvement. Use 63191 when the spinal accessory nerve is the operative target.
- 63190Spinal rhizotomy
- 63190 concerns a spinal nerve procedure involving more than two segments. It is not the code for incision of the spinal accessory nerve.
- 63170Spinal cord surgery
- 63170 involves incision of spinal cord tracts. Choose 63191 when the documented target is the spinal accessory nerve instead.
63191 billing questions
How does 63191 differ from spinal nerve root incision codes?
63191 targets the spinal accessory nerve. Codes 63185 and 63190 concern spinal nerve procedures distinguished by the extent or segment involvement.
Is this code appropriate for every operation for cervical dystonia?
No. Report it when the spinal accessory nerve is the nerve surgically incised or divided; a different operative target calls for its own code.
Can modifier 50 be used for bilateral treatment?
CMS identifies this as a bilateral procedure. Bilateral reporting with modifier 50 is paid at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
May an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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